Benefit-risk assessment of vitamin D supplementation

被引:241
作者
Bischoff-Ferrari, H. A. [1 ,2 ]
Shao, A. [3 ]
Dawson-Hughes, B. [4 ]
Hathcock, J. [3 ]
Giovannucci, E. [5 ]
Willett, W. C. [5 ]
机构
[1] Univ Zurich Hosp, Ctr Aging & Mobil, Dept Rheumatol, CH-8091 Zurich, Switzerland
[2] Univ Zurich Hosp, Inst Med Phys, CH-8091 Zurich, Switzerland
[3] Council Responsible Nutr, Washington, DC USA
[4] Tufts Univ, USDA, Human Nutr Res Ctr Aging, Boston, MA 02111 USA
[5] Harvard Univ, Sch Publ Hlth, Dept Nutr, Boston, MA 02115 USA
关键词
Falls; Fractures; Hypercalcemia; Recommendations; Risk; Vitamin D; RANDOMIZED CONTROLLED-TRIAL; PLACEBO-CONTROLLED TRIAL; NURSING-HOME RESIDENTS; HIGH-DOSE VITAMIN-D-3; NUTRITION EXAMINATION SURVEY; PARATHYROID-HORMONE LEVELS; TRUE CALCIUM-ABSORPTION; AFRICAN-AMERICAN WOMEN; 3RD NATIONAL-HEALTH; D INTOXICATION;
D O I
10.1007/s00198-009-1119-3
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Current intake recommendations of 200 to 600 IU vitamin D per day may be insufficient for important disease outcomes reduced by vitamin D. This study assessed the benefit of higher-dose and higher achieved 25-hydroxyvitamin D levels [25(OH)D] versus any associated risk. Based on double-blind randomized control trials (RCTs), eight for falls (n = 2426) and 12 for non-vertebral fractures (n = 42,279), there was a significant dose-response relationship between higher-dose and higher achieved 25(OH)D and greater fall and fracture prevention. Optimal benefits were observed at the highest dose tested to date for 700 to 1000 IU vitamin D per day or mean 25(OH)D between 75 and 110 nmol/l (30-44 ng/ml). Prospective cohort data on cardiovascular health and colorectal cancer prevention suggested increased benefits with the highest categories of 25(OH)D evaluated (median between 75 and 110 nmol/l). In 25 RCTs, mean serum calcium levels were not related to oral vitamin D up to 100,000 IU per day or achieved 25(OH)D up to 643 nmol/l. Mean levels of 75 to 110 nmol/l were reached in most RCTs with 1,800 to 4,000 IU vitamin D per day without risk. Our analysis suggests that mean serum 25(OH)D levels of about 75 to 110 nmol/l provide optimal benefits for all investigated endpoints without increasing health risks. These levels can be best obtained with oral doses in the range of 1,800 to 4,000 IU vitamin D per day; further work is needed, including subject and environment factors, to better define the doses that will achieve optimal blood levels in the large majority of the population.
引用
收藏
页码:1121 / 1132
页数:12
相关论文
共 131 条
[1]   A randomized controlled trial of vitamin D3 supplementation in African American women [J].
Aloia, JF ;
Talwar, SA ;
Pollack, S ;
Yeh, J .
ARCHIVES OF INTERNAL MEDICINE, 2005, 165 (14) :1618-1623
[2]  
Aloia JF, 2008, AM J CLIN NUTR, V87, P1952
[3]  
[Anonymous], 1997, Dietary reference intake for calcium, phosphorus, magnesium, vitamin D, and fluoride
[4]  
Atabek ME, 2006, J PEDIATR ENDOCR MET, V19, P169
[5]   Vitamin D and its major metabolites: Serum levels after graded oral dosing in healthy men [J].
Barger-Lux, MJ ;
Heaney, RP ;
Dowell, S ;
Chen, TC ;
Holick, MF .
OSTEOPOROSIS INTERNATIONAL, 1998, 8 (03) :222-230
[6]   Acute vitamin D intoxication in a child [J].
Barrueto, F ;
Wang-Flores, HH ;
Howland, MA ;
Hoffman, RS ;
Nelson, LS .
PEDIATRICS, 2005, 116 (03) :E453-E456
[7]   Oral bisphosphonate therapy for vitamin D intoxication of the infant [J].
Bereket, A ;
Erdogan, T .
PEDIATRICS, 2003, 111 (04) :899-901
[8]  
Berlin T, 1987, Contrib Nephrol, V58, P143
[9]   STUDIES ON THE RELATIONSHIP BETWEEN VITAMIN-D3 STATUS AND URINARY-EXCRETION OF CALCIUM IN HEALTHY-SUBJECTS - EFFECTS OF INCREASED LEVELS OF 25-HYDROXYVITAMIN-D3 [J].
BERLIN, T ;
EMTESTAM, L ;
BJORKHEM, I .
SCANDINAVIAN JOURNAL OF CLINICAL & LABORATORY INVESTIGATION, 1986, 46 (08) :723-729
[10]   Effects of vitamin D and calcium supplementation on falls:: A randomized controlled trial [J].
Bischoff, HA ;
Stähelin, HB ;
Dick, W ;
Akos, R ;
Knecht, M ;
Salis, C ;
Nebiker, M ;
Theiler, R ;
Pfeifer, M ;
Begerow, B ;
Lew, RA ;
Conzelmann, M .
JOURNAL OF BONE AND MINERAL RESEARCH, 2003, 18 (02) :343-351